Add And Cpd-------------

Front 1

ADHD pathophysiology

Back 1

1)deficiency of NE and DA at synapse in frontal and neostriatial systems
-accounts for phasic patterns of symptoms

Front 2

What are the 3 main symptoms of ADHD? (ADHD TRIAD)

Back 2

1)inappropriate inattention
2)impulsivity
3)hyperactivity

Front 3

What is the first treatment option for children with ADHD?

Back 3

1)Non-pharmacologic therapy
-education, behavioral therapy

Front 4

What is the first line class of agents for ADHD?

Back 4

central nervous system stimulates

Front 5

What is the next step if one agein in the class fails?

Back 5

Try another stimulant agent

Front 6

CNS stimulants MOA

Back 6

1)increases release of DA and NE from presynaptic nerve
2)inhibit reuptake of DA and NE
3)inhibit MAO

Front 7

What types of CNS stimulants should you start out with?

Back 7

Short-acting CNS stimulants (BID-TID)

Front 8

Generic for Adderall

Back 8

amphetamine-dextroamphetamine

Front 9

Generic for Ritalin

Back 9

methylphenidate

Front 10

Generic for Dexedrine or Dextrostat

Back 10

dextroamphetamine

Front 11

What is the initial daily dose of methylphenidate?

Back 11

1)0.3mg/kg/dose BID to TID
2)3-5yrs = 5mg
3)=>6 = 10mg

Front 12

What is the maximum dose for Adderall

Back 12

1)3-5yrs = 40mg
2)=>6yrs = 40mg

Front 13

What is the maximum dose for Ritalin?

Back 13

1)0.6mg/kg/dose
OR
2)60mg

Front 14

This long-acting stimulant is a patch that is intended for 9 hours of wear and can be found in the blood stream for up to 3 hours after removal. It also takes 2 hours to take effect.

Back 14

Daytrana (methylphenidate)

Front 15

This long-acting stimulants side effect includes a tablet form expelled from the stool

Back 15

Concerta (methylphenidate

Front 16

Side effects of CNS stimulants

Back 16

1)HA
2)decreased appetite (increased prevelance w/long acting agents)
3)insomnia ('')
4)exacerbate tics
5)delayed growth (drug holidays)
6)increase HR and BP
7)patch can irritate skin

Front 17

Contraindications to stimulants

Back 17

1)pre-existing cardiac abnormalities
2)Agitation
3)hypersensitivity
4)suicidal thoughts?
5)Tourettes

Front 18

What are 7 other drugs/classes of agents that can be used only if stimulants fail or are contraindicated?

Back 18

1)pemoline
2)TCAs
3)bupropion
4)venlaxafine
5)MAOI
6)alpha-adrenergic agonists
7)atomoxetine (Strattera)

Front 19

pemoline MOA

Back 19

dopamine agonist w/ long t1/2 allowing for QD dosing

Front 20

advantages of pemoline

Back 20

1)similar efficacy
2)schedule IV controlled substance

Front 21

disadvantages of pemoline

Back 21

1)fulminant hepatic failure (LFT monitoring is NOT predictve---BLACK BOX WARNING----

Front 22

disadvantages of TCAs

Back 22

1)side effect profile
2)must titrate on and off
3)desipramine may place child at cardiac risk

Front 23

bupropion disadvantages

Back 23

1)exacerbated tics
2)not FDA approved

Front 24

venlaxafine MOA

Back 24

inhibits reuptake of NE and 5-HT

Front 25

venlaxafine side effects

Back 25

1)mild nausea most common
2)increase in blood pressure that is dose dependent

Front 26

what alpha-adrenergic agonists have been used with success?

Back 26

clonidine and guanfacine

Front 27

atomoxetine MOA

Back 27

1)Selective NE reuptake inhibitor
2)NONSTIMULANT, NON CONTROLLED substance

Front 28

atomoxetine side effects

Back 28

1)somnolence
2)anorexia

Front 29

atomoxetine drug interactions

Back 29

1)metabolized via CYP P450 2D6 pathway
-7% of population are poor metabolizers

Front 30

atomoxetine dosing

Back 30

1)1-2mg/kg/day in pediatrics
2)adults should not exceed 100mg/day

Front 31

What is the definition of tourette's d/o?

Back 31

A chronic familial d/o characterized by multiple MOTOR TICS with one or more VOCALIZATION TIC

Front 32

Examples of motor tics

Back 32

twitching, jerking, rapid mouth movements, rapid muscle movements

Front 33

Vocal tics
-phonic tics
-coprolalia

Back 33

1)98% have phonic tics
2)<30% have coprolalia

Front 34

How is tourette's d/o diagnosed?

Back 34

must have tics for 1yr or more for diagnosis

Front 35

What is the age of onset?

Back 35

2-15

Front 36

What is first line therapy for Tourette's d/o?

Back 36

behavioral and psychotherapy

Front 37

What 3 agents have shown efficacy in tourette's d/o?

Back 37

1)haloperidol
2)pimozide
3)clonidine (less effecive)

Front 38

Which agents for tourette's d/o cause EPS?

Back 38

haloperidol and pimozide

Front 39

Clonidine MOA

Back 39

1)reducs sympathetic ouflow via stimulation of alpha-2 receptors in CNS
2)acts as an adrenergic agonist

Front 40

What is the difference between primary and secondary enuresis

Back 40

primary enuresis indicates the child has never established urinary continence, secondary follows an established period (3-6months) of urinary continence

Front 41

What is the initial therapy for enuresis?

Back 41

1)education is key
2)discourage punishment
3)behavioral and condiationing methods

Front 42

What are examples of behavioral and condiationing methods?

Back 42

1)bed alarms
2)no fluids after 6
3)set wake up patterns to void
-may take up to 3-4months but 70% effective

Front 43

If drug therapy is initiated, attempts to d/c should be made every _____ to assess for spontaneous remission

Back 43

3-6months

Front 44

What is the efficacy of imipramine?

Back 44

70-85%
-half will have complete resolution, half will have decreased number of episodes

Front 45

imipramine dosing issues

Back 45

1)initial 25mg QHS w/ increases of 25mg/week if needed
2)avg dose is 75mg in children and 150mg in teens
3)initially effect dose will become ineffective in 2-6weeks. Dose will need to be titrated up to reestablish control

Front 46

Alternative agent for enuresis

Back 46

Desmopressin acetate (DDAVP)

Front 47

Efficacy of DDVAP

Back 47

1)70%
2)better results in children over 9years
3)duration of effect is 6-24hours

Front 48

What is the dose (intranasal) for DDAVP ***KNOW***

Back 48

1)20mcg QHS which can be increased to 40mcg after 3 nights if success is not seen
2)half of dose is given in each nostril

Front 49

DDAVP adverse effects

Back 49

Infrequent
1)nasal irritation
2)epistaxis
3)nausea
4)chills
5)HA

Front 50

What is a very important counseling point with DDAVP?

Back 50

evening fluids should be limited to 8ozs to prevent hyponatremia or water intoxication

Front 51

What is the treatment for Munchausen's syndrome by proxy?

Back 51

remove child from the home until parent undergoes psychiatric evaluation